Why you should care

I. W. Gregorio was completing her medical residency, a stint in pediatric urology, when she met the person who would change her life. It was a young patient with Androgen Insensitivity Syndrome, or AIS, a genetic condition in which a person with XY chromosomes develops a female body. It’s one of the more common forms of intersexuality, and Gregorio participated in the young woman’s surgery and helped guide her in finding a support group. They never spoke after that, but Gregorio always wondered about her, and, years later, was inspired by her.

So Gregorio wrote about her — sort of. Her first novel, None of the Above, tells the story of a teenage girl who discovers she has AIS. It’s just one of several books in recent years that has begun to explore the concept of intersexuality in stories aimed at teens. It’s difficult to ascertain how many people are intersex, especially because some of the conditions are subtle and may be missed until a patient hits puberty (or even afterward), but the Intersex Society of North America estimates that about 1 in every 1,500 to 2,000 babies born has noticeably atypical genitalia.

We have a responsibility to give people hope. If people grow up thinking their narrative is going to be one of despair and tragedy, that’s doing them a disservice.

I. W. Gregorio

Gay and lesbian characters have populated young adult novels since at least the late 1960s, but the types of stories told about queer youth who live outside of typical YA stories is ever-evolving. According to B.J. Epstein, a senior lecturer at the University of East Anglia, these changes tend to evolve in stages. The first few young adult novels about gay teens tended to show sad, fairly lonely stories of white adolescents questioning their sexuality and dealing with rejection from society and their parents. Later on, stories about gay characters became more nuanced. There are still plenty of coming-out narratives, Epstein says, but also more stories about gay teens who live outside of typical YA stories involving crushes (on vampires, natch), bullies and fighting with parents, and who don’t really struggle with their sexuality.

More recently, transgender characters have become far more common in young adult and children’s literature, and Epstein says she’s noticed a few bisexual and asexual characters as well. Intersexuality got the highbrow treatment in Jeffrey Eugenides’ Middlesex, but when it comes to educating the masses, some may want a newer, well-written teenage story — such as Alyssa Brugman’s Alex as Well, Bridget Birdsall’s Double Exposure or Gregorio’s None of the Above, published last year.

Gregorio’s protagonist, Kristin, is purposefully a girl next door. She’s the homecoming queen, a star runner with a hot boyfriend, and a healthy attitude toward sex and using protection — which all get a bit derailed when she’s unexpectedly diagnosed with AIS. She loses the boyfriend, her popularity, her friends — and, as an athlete, has to battle prejudices similar to those that nearly destroyed intersex runner Caster Semenya’s career in 2009. But in the end (spoiler alert!), None of the Above delivers the happy shiver of teenage romance and mended friendships that’s the hallmark of some best-selling YA novels. This isn’t a sad story, nor is it meant to be. “We have a responsibility to give people hope,” Gregorio says. “If people grow up thinking their narrative is going to be one of despair and tragedy, that’s doing them a disservice.”

Even so, Birdsall was inspired to write Double Exposure following a deep tragedy: Her nephew committed suicide after constant bullying at school over his sexuality. “I think it’s hard for people who are different,” says Birdsall, who penned the story of a 15-year-old named Alex who finds out she’s intersex and decides to live as a girl despite having been raised as a boy. Birdsall sees YA literature about intersex teenagers as a game changer for the morality police when it comes to discussing sex and gender. Intersexuality is a medical condition and it can’t be denied, she argues, but stories about intersex people are often by default stories about queer culture as well.

To be sure, there have only been a few books written about intersex teenagers, and those books may not be making it to their intended audience. While Gregorio says she’s had a good reception from teens — one 12-year-old wrote her a letter saying the book gave her courage to reach out — she says some librarians and booksellers have seen her book as a hard sell or an “issue” book, one to be passed on to struggling intersex teens rather than distributed at large. Any topic remotely sexual in nature in the hands of teenagers tends to raise hackles on parents and teachers, even when it’s a medical condition — especially in well-told stories in which teenagers have (admittedly quite responsible) sex with each other.

But Gregorio has a trump card that few others can pull out: She’s a surgeon. “I have authority as a doctor,” she says. “That allays a lot of people’s fears.”